Clinical charcteristics and risk factors of severity of covid19 infection in patients with hematological malignancies

Background: Patients with hematologic malignancies are considered particularly vulnerable to COVID 19 infection due to their underlying malignancy and their anticancer therapy. However, there are still few data on risk factors of mortality in this population. Aims: This study aimed to determine the clinical and biological caracteristics of COVID-19 infection in hematologic patients and the risk factors of COVID-19 severity and mortality Methods: This prospective study included all consecutives COVID 19 infected patients, treated for hematologic malignancies in the clinical hematology department of Aziza Othmana Hospital, between October 2020 and January 2021. Covid 19 infection was confirmed by PCR or rapid antigenic analysis of a nasopharyngal swab. We collected clinical, biological, radiological and outcomes data Results: No cases of COVID 19 infection was diagnosed in our departement during the first COVID 19 wave. The first confirmed case was diagnosed on 12th october 2020. A total of 68 patients was included. Median age was 47 years with a sex ratio of 1.5. Twenty-nine (43%) patients were treated for acute leukemia, 24 (37%) for lymphoma, 6 (9%) for chronic lymphocytic leukemia, 6 (9%) for multiple myeloma and 3 (4%) for myelodysplastic syndrome. Forty-three patients (63%) had active disease (AD) while 37% were in remission (RD). Thirty-three patients (46%) had at last 1 comorbidity including diabetes (16%) and obesity (9%). The main symptoms of the infection were fever (63%), cough (49%), dyspnea (40%) and diarrhea (30%). Seventeen patients had a chest scanning, 12 of them (70%) had a damage greater than 25% of the surface area of the lungs (60% and 85% in the AD and RD groups respectively [p=0.15]). During the infection, 44% of patients had lymphopenia and 21% grade 4 neutropenia. Median dosage of C reactive Protein was of 154 mg/l [1.9-658]. Twenty (29%) patients developped severe infection (37% and 16% in the AD and RD groups respectively [p=0.09]). Seven (10%) of them required admission in an intensive care unit (14% and 4% of the AD and RD groups respectively[p=0.14]). Significant risk factors of the severity of the infection were: age >45 years (p= 0.008), the presence of at least 1comorbidity (p=0.009), dyspnea (p< 0.0001) and a dosage of C reactive protein superior to 150 mg/l (p =0.033). Twelve patients (18%) died from COVID19 infection (23% and 8% in the AD and RD groups respectively[p=0.11]). Dyspnea and grade 4 neutropenia were the independent risk factors of death (p=0.011 and p=0.049 respectively). Summary/Conclusion: In this study of patients with hematological malignancies, high rates of COVID19 infection severity and associated mortality was noted especially in neutropenic patients. Although no difference was observed in the radiological severity between AD and RD groups, there was a trend to a more clinically severe infection in the AD group.